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["附件3"]
["第九届贵州人才博览会\n州委组织部干部录用考试中心引进高层次人才考试\n个人防疫情况申报表"]
["姓名",null,"性别",null,"年龄"]
["身份证号",null,null,"手机号码"]
["工作单位或学校"]
["近14天旅居史、健康史及接触史情况"]
["是否有国外旅居史",{"$nulls":3},"是£","否£"]
["是否有港、台旅居史",{"$nulls":3},"是£","否£"]
["是否有高、中风险地区旅居史",{"$nulls":3},"是£","否£"]
["是否曾被诊断为新冠肺炎确诊病例或无症状感染者",{"$nulls":3},"是£","否£"]
["是否与新冠肺炎确诊病例或无症状感染者有密切接触",{"$nulls":3},"是£","否£"]
["是否有与来自高、中风险疫情地区人员有密切接触",{"$nulls":3},"是£","否£"]
["密切接触的家属及同事是否有发热等症状",{"$nulls":3},"是£","否£"]
["密切接触的家属及同事是否有中高风险地区、港台及国外境外旅居史",{"$nulls":3},"是£","否£"]
["本人2021年5月    日以来健康状况：发热£  乏力£  咽痛£  咳嗽£  腹泻£"]
["其它需要说明的情况："]
["本人对上述提供的健康相关信息的真实性负责。如因不实信息引起疫情传播和扩散，本人愿承担由此带来的全部法律责任。                                                                              \n\n\n                        \n                             承诺人：                        年   月   日                                                                 "]

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